The Variety of Cardiovascular Presentations of COVID-19

Fried, Justin; Ramasubbu, Kumudha; Bhatt, Reema; Topkara, V.K.; Clerkin, Kevin J.; Horn, Evelyn M.; Rabbani, Le Roy E.; Brodie, Daniel; Jain, Sneha; Kirtane, Ajay J.; Masoumi, Amirali; Takeda, Koji; Kumaraiah, Deepa; Burkhoff, Daniel; Leon, Martin B.; Schwartz, Allan; Uriel, Nir; Sayer, Gabriel

doi:10.1161/circulationaha.120.047164

Cited by 516 publications

(558 citation statements)

References 5 publications

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“…In addition, some of these patients may have a "STEMI-mimicker" such as focal myocarditis or stress cardiomyopathy known to be associated with COVID-19 13,14 . Fibrinolysis of these patients would provide no benefit to the patient, but still incur bleeding risk and eventual invasive diagnostic catheterization given that the ST-elevation is unlikely to resolve.…”

Section: ) Patients Presenting With Stemi To a Primary Pci Center A)mentioning

confidence: 99%

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Mahmud

Dauerman

Welt

et al. 2020

Journal of the American College of Cardiology

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367

199

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The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 . Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating a STelevation MI presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.

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Section: ) Patients Presenting With Stemi To a Primary Pci Center A)mentioning

confidence: 99%

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Mahmud

Dauerman

Welt

et al. 2020

Journal of the American College of Cardiology

Self Cite

367

199

View full text Add to dashboard Cite

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“…Interestingly, a combination of inhibitors of both proteases blocked the virus entry in vivo effectively [22]. Given the vast representation of the receptors as mentioned above in human tissues, the virus itself has a broad capacity to infect various human cell types and induce different pathogenic chains of events that correspond with a variety of clinical pictures of COVID-19 [14,24,25]. Viral replication begins in the ciliated epithelium of the nasal cavity with the highest expression of its receptors in the goblet/secretory cells and the highest virus yield found in nasal swabs [18,24].…”

Section: The Sars-cov-2 Virus Its Transmission and Entry Pointsmentioning

confidence: 99%

COVID-19 — Toward a comprehensive understanding of the disease

et al. 2020

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The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Elucidating why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on unraveling of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a comprehensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, the authors present a combined viewpoint based on the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on. (Cardiol J 2020; 27, 2: 99-114)

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“…Elevated cardiac biomarkers have been identified in COVID-19 patients, especially in those with severe conditions. Of note, recent case reports highlighted cardiac involvement as a complication associated with COVID-19, even without respiratory symptoms [30,52]. Myocardial injury, defined as elevated cardiac biomarkers, was found in five of the first 41 patients (12%) with COVID-19 in Wuhan, which mainly manifested as an increase in high-sensitivity cardiac troponin I (hs-cTnI) levels (>28 pg/mL) [8].…”

Section: Myocardial Injurymentioning

confidence: 99%

“…Moreover, the first description of critically ill patients from the United States indicated that 33% of the ICU patients developed cardiomyopathy [50]. Most recently, Fried et al described three cases of COVID-19 infection with acute systolic heart failure [30], suggesting that isolated myocarditis, myocarditis secondary to cytokine storm, stress-cardiomyopathy, and hypoxemia on underlying cardiovascular disease could be considered as potential mechanisms of left ventricular dysfunction. However, given the scarce availability of data regarding this topic, it remains unclear whether the acute heart failure following COVID-19 is mainly due to exacerbation of pre-existing cardiac dysfunction or new-onset cardiomyopathy.…”

Section: Decompensated Heart Failure and Mixed Shockmentioning

confidence: 99%

“…The most common radiographic findings are ground-glass opacity (56%) and bilateral patch shadowing (52%) on computed tomography (CT) [27]. Electrocardiogram may show nonspecific ST-T abnormalities in some cases [30,31], but the prevalence remains unknown. In laboratory tests, lymphocytopenia is commonly observed (83%) and most patients have elevated serum levels of C-reactive protein and proinflammatory cytokines [7,10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 on the Cardiovascular System: A Review

Matsushita

Marchandot

Jesel

et al. 2020

JCM

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The recent outbreak of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 has been declared a public health emergency of international concern. COVID-19 may present as acute respiratory distress syndrome in severe cases, and patients with pre-existing cardiovascular comorbidities are reported to be the most vulnerable. Notably, acute myocardial injury, determined by elevated high-sensitivity troponin levels, is commonly observed in severe cases, and is strongly associated with mortality. Therefore, understanding the effects of COVID-19 on the cardiovascular system is essential for providing comprehensive medical care for critically ill patients. In this review, we summarize the rapidly evolving data and highlight the cardiovascular considerations related to COVID-19.

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The Variety of Cardiovascular Presentations of COVID-19

Abstract: Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Uriel and Sayer), who respond to the information and share their reasoning with the reader (regular type). A discussion by the authors follows.

Cited by 516 publications

References 5 publications

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

COVID-19 — Toward a comprehensive understanding of the disease

Impact of COVID-19 on the Cardiovascular System: A Review

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